E-ISSN:2456-3110

Research Article

Anovulation

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 1 January
Publisherwww.maharshicharaka.in

Comparative clinical evaluation of Jeevantyadi Yamaka Matra Basti and Uttara Basti in Bandhyatva (Anovulation)

Purohit R1*, Gupta A2, Khot P3, Vandana4
DOI:10.21760/jaims.9.1.1

1* Rupali Purohit, Post Graduate Scholar, Dept of Panchakarma, Himalayiya Ayurvedic Pg College Hospital Doiwala, Dehradun, Uttarakhand, India.

2 Arvind Gupta, Professor HOD, Dept of Panchakarma, Himalayiya Ayurvedic PG College Hospital Doiwala, Dehradun, Uttarakhand, India.

3 Poonam Khot, Associate Professor, Dept of Stri Roga Prasuti Tantra, Himalayiya Ayurvedic PG College Hospital Doiwala, Dehradun, Uttarakhand, India.

4 Vandana, Assistant Professor, Dept of Panchakarma, Himalayiya Ayurvedic PG College Hospital Doiwala, Dehradun, Uttarakhand, India.

Introduction: Infertility is presently a leading and longstanding gynaecological issue affecting approximately 15% of the couples in reproductive age group around the globe while 10-15% in Indian population. Ovulatory dysfunctions form the major cause of female infertility, out of which Anovulation accounts for 40%. Anovulation can be interpreted as Abeejotsarga or Abeejata. Panchakarma plays an important role in the management of Infertility. Thus, the present study aimed at evaluating the ovulation inducing effect of Jeevantyadi Yamaka through Matra Basti and Uttara Basti. Methodology: The study was conducted on 40 female subjects, diagnosed of anovulation with either primary or secondary infertility, fulfilling the inclusion and exclusion criteria and were randomly allocated into two groups with 20 subjects in each. But only 33 patients completed the trial with 18 patients in Group A and 15 patients in Group B. Group A received Jeevantyadi Yamaka Matra Basti while Group B were administered with Jeevantyadi Yamaka Uttara Basti for a period of three menstrual cycles. The assessment of results was done by follicular study conducted from 9th day of menstrual cycle till 20th day of every cycle for consecutive three cycles. Results: Both the groups showed significant improvement in assessment parameters. Although the number of patients were less in Group B than Group A but Ovulation was observed in 5.5% of subjects in Group A and 40% of subjects in Group B. Discussion: Jeevantyadi Yamaka Matra Basti and Uttara Basti both are equally effective in increasing the size of follicles and other assessment parameters. But in overall, Jeevantyadi Yamaka Uttara Basti was more effective in achieving Ovulation due to its local effect. As, this study was only for three months so no result was seen on Conception

Keywords: Bandhyatva, Infertility, Anovulation, Uttara Basti, Matra Basti, Jeevantyadi Yamaka

Corresponding Author How to Cite this Article To Browse
Rupali Purohit, Post Graduate Scholar, Dept of Panchakarma, Himalayiya Ayurvedic Pg College Hospital Doiwala, Dehradun, Uttarakhand, India.
Email: 		Purohit R, Gupta A, Khot P, Vandana, Comparative clinical evaluation of Jeevantyadi Yamaka Matra Basti and Uttara Basti in Bandhyatva (Anovulation). J Ayu Int Med Sci. 2024;9(1):1-14.
Available From
https://jaims.in/jaims/article/view/2859

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-11-14 2023-11-21 2023-11-28 2023-12-11 2023-12-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 18.55

© 2024by Purohit R, Gupta A, Khot P, Vandanaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Rupali Purohit et al. Evaluation of Jeevantyadi Yamaka Matra Basti in Bandhyatva

Introduction

According to WHO, Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.[1] It affects approximately 10-15% of reproductive couples. The WHO estimates the overall prevalence of primary infertility in India to be between 3.9 and 16.8 percent.[2] According to International Federation of Gynaecology and Obstetrics (FIGO) manual, ovarian factor contributes 15-25% in causes of the female infertility.[3] So, it is the second common cause of infertility. Ovulatory cause is an important subset in infertility among women, accounting about 40% of cases. (Infertility of Leon Sperrof et.al).[4] Anovulatory or inability to produce a fertile ovum is an important cause among the women for infertility. In modern science there is treatment of infertility (due to anovulation) which includes usage of Ovulation induction by Human Menopausal Gonadotrophins (HMG) Injections, Gonadotrophins, Clomiphene Citrate etc. but they have unsatisfactory results, enormous expenses and lots of side effects like ovarian hyper stimulation, frequent abortion, multiple gestations, and major long-time possibility of ovarian cancer. In this Particular disease, treatment which improves quality of life with nil or minimal side effects is the need of hour.

In Ayurveda, Bandhya can be defined as the cessation of Artava.[5] According to Ayurveda, Fertility of women depends on the healthy states of Ritu (appropriate time), Kshetra (healthy Uterus and passage), Ambu (proper nutrition of mother) and Beeja (healthy ovum and sperm).[6] Imperfection in any one of them leads to Bandhyatva (Infertility). Among them Beeja is the core stone of the female reproductive process and in its absence Garbha- Fetus cannot be formed in spite of all the other factors. Here the Beeja is taken as Antahpushpa[7] i.e., ovum. So, anovulation can be included under Beeja Dushti.

Vata is considered to be the root cause of all the disorders cognate to the female reproductive system including female infertility. Without Vata, the Yoni (Female genital organs) never gets spoiled. Moreover, the most important functions of Vayu are Vibhajana and Pravartana. Because of Vibhajana, Ovum is prepared in the ovary by cell division

and because of Pravartana Ovulation takes place. This function of cell division to form ovum is completed by Vata. The whole activity is known as Dhatu Vyuha Kara i.e., it places every Dhatu at its proper place, which is also an important function of Vata. The process of Pravartana is governed by Apana Vayu.[8] Therefore, we can say that ovulation is under the control of Vata. Therefore, any vitiation of Apana Vata will affect the ovulation. In this aspect, Basti is considered to be the best treatment for Vata. Basti cures all the disease of Vata.[9] So, it may act on anovulation by normalising the pelvic reproductive physiology. In Ayurveda, Anovulation refers to Abeejotsarga. The Term Utsarga means to expel or to leave. So, Expulsion of matured ovum from the Beejagranthi means Beejotsarga. As Utsarga is Karma of Vata so vitiation of Apana Vata Dosha causes Abeejotsarga. Abeejotsarga is symptom as well as a disease caused due to vitiation of Vata and Kapha Doshas as they do Marga-Avarodha to Artavaha Strotas leading to Abeejotsarga.[10]

Acharya Vaghbhatta has mentioned Jeevantyadi Yamaka Anuvasana Basti for Bandhyatva.[11] Yamaka is a combination of Ghrita and Taila which itself is Vata Shamaka and Taila is also mentioned as Yonivishodhaka. Moreover, all the contents of Jeevantyadi Yamaka are Vata Shamaka mostly with Laghu, Ushna, Tikshna property like Satapushpa, Shati, Vacha, and most of them like Jeevanti, Sauf, Vacha, Karkatashringi, Madan, Pippali having Vatanulomaka property and so it will be probably act on anovulation. According to Acharya Kashyapa, the women having amenorrhea, Scanty menstruation, non-ovulation or useless ovulation (ovum with minimal or absence of capacity of fertilization) should be treated with Matra Basti.[12] In condition of anovulation, Uttar Basti removes the Srotosangha and corrects the Artavagni which regulates the menstrual cycle, thus resulting in ovulation. So here, Jeevantyadi Yamaka for Matra Basti and Uttara Basti is selected for the study. This study is related to anovulatory cycle so only Females are considered.

Aims and Objectives

1. To find out the efficacy of Jeevantyadi Yamaka Matra Basti in Anovulation.
2. To find out the efficacy of Jeevantyadi Yamaka Uttara Basti in Anovulation.


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3. To compare the efficacy of Jeevantyadi Yamaka Matra Basti and Jeevantyadi Yamaka Uttara Basti in Anovulation.

Materials and Methods

The materials used for this study are categorised under the following three headings -

1. Literary Sources - For the present Study, Literary data was collected from Vedic Scriptures, Ayurvedic Samhitas and Sanskrit Retrospective study of database-books related to modern Science, research studies published in peered-review journals and conference proceedings and various web-sources like GOOGLE, DHARA etc. was done for seeking information about related research work.

2. Drug source - For the preparation of Jeevantyadi Yamaka, Raw drug was collected from Herbal Automation, Haridwar and prepared in pharmacy of Himalayiya Ayurvedic Medical College and Hospital, Dehradun.

Plan of Study

1. Selection of Patient
2. Research design
3. Assessment

Selection of Patients

In total, 50 female patients were screened on the basis of signs and symptoms showing classical features of the Bandhyatva due to Anovulation in the OPD and IPD of P.G. Department of Panchakarma and Department of Stree Rog and Prasuti Tantra, Himalayiya Ayurvedic (P.G) Medical College and Hospital, Dehradun. Total 40 patients were enrolled irrespective of religion, socio-economic conditions, etc. Enrolled patients were randomly divided into 2 groups, 20 patients were registered in each group with detailed clinical study, physical examination and investigation in a special proforma.

Research Design

  • Study design - Randomized Clinical Comparative Trial
  • Masking - Open type (As Masking was not possible with Panchakarma procedure)
  • Randomization - The patients were randomised using Computer generated randomization.
  • Sample Size and Grouping: 40 patients of Bandhyatva due to Anovulation were randomly selected and equally divided into 2 groups.
    • Group A: 20 patients received Matra Basti with Jeevantyadi Yamaka.
    • Group B: 20 patients received Uttara Basti with Jeevantyadi Yamaka
  • Level of Study: OPD and IPD level
  • Period of Study: 18 Months
  • Duration of Treatment: 3 Months
  • Ethical committee Clearance (Reference No.) - As this is a clinical study, Institutional Ethical Committee (IEC) approval was taken in prior to initiation of the study with the Reference no. - HAMC/2021/968
  • CTRI Registration - This clinical study was registered in Clinical Trial Registry of India (CTRI) with the registration no. CTRI/2022/09/045244

Inclusion Criteria

  • Married Female Patients from 20 - 40 years of age.
  • Patients having active married life (minimum 1 year)
  • Patients with at least 2 or more consecutive anovulatory cycles in serial Trans Vaginal Sonography.
  • Patients with Primary or secondary both types of infertility.
  • Patients having anovulatory cycle with or without PCOD.
  • Patients who will be ready for consent, necessary investigations and regular follow up.

Exclusion Criteria

  • Patients suffering from the disorders of the reproductive tract such as tuberculosis, carcinoma, and congenital deformity of reproductive tract.
  • Patients suffering from Systemic diseases like Tuberculosis, Uncontrolled Hypertension and Diabetes Mellitus, Cardiac Disease, Thyroid disease and Hyperprolactinemia, STDs, HIV, HBsAg.
  • Patient suffering from fibroids, endometriosis, adenomyosis.

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  • Infertility associated with other factors like tubal blockage, uterine factors, cervical factors etc.
  • Menorrhagia, Metrorrhagia, Dysfunctional Uterine Bleeding (DUB)

Table 1: Showing Method of Intervention

Intervention NameGroup AGroup B
Selected DrugsFor Snehana - Tila Taila
For Swedana - Nadi Sweda with Dashmoola Kwatha
For Matra Basti - Jeevantyadi Yamaka		For Mridu Virechana - Haritki Churna (3 gm)
For Yoni Dhawan - Panchavalkal Kwath (500 ml)
For Snehana - Tila Taila
For Swedana - Nadi Swedana with Dashmoola Kwath
For Uttara Basti - Jeevantyadi Yamaka
Dose of Medicine60 ml5 ml
Route of AdministrationRectal RouteVaginal Route
Procedure
Purva KarmaBefore administration of Basti, Patients were asked to take light meal. Then, Sthanika Abhyanga with Tila Taila and Sthanika Swedana with Dashmoola Kwath were done on the region of Udara, Kati and Prishtha Pradesh.On each Night Before the Uttara Basti Administration, Haritki Churna in Dose of 3 gm was given in lukewarm water for cleaning the bowels. Sthanika Abhyanga with Tila Taila and Sthanika Swedana with Dashmoola Kwath were done over Udara, Kati and Prishtha Pradesh. All the instruments used during the procedure including the medicine were autoclaved and kept ready. Yoni Prakshalana was done with Panchavalkal Kwath.
Pradhana KarmaPatients were advised to take left lateral position with left straight and right leg flexed on knee and hip joint and were asked to keep their left hand below the head. Enema nozzle was pushed into rectum after lubricating nozzle and Guda. Then, Jeevantyadi Yamaka Matra Basti was administered slowly in the dose of 60 ml.The patient is examined for the parameters like BP, pulse, temperature etc. before she is put to table. Then the patient is kept in lithotomy position with the part exposed, cleaned and draped. The part is covered with the ring towel and only the perineum is exposed. Later the lubricated Sim’s speculum is slowly inserted to expose the cervix and held with Allis forceps. After that, Os is dilated using Hegar’s dilators. After dilating the Os, the lubricated IUI cannula is carefully introduced to the uterus through the cervix. Then, 5 ml of Jeevantyadi Yamaka is injected gently with the help of disposable syringe of 5 ml attached from the other side of IUI Canula (after removing the air bubble)
Paschat KarmaAfter the administration of Basti, the patients were advised to lie in supine position with the arms and legs spread out freely over the table. Buttocks of the patient were patted with palms for 3 times and patient was advised to relax in supine position.Patient was kept in head low position for at least 2 hours for better absorption of drug from vagina and to prevent any vasovagal shock. Abdominal hot fomentation with hot water bag was given. Light diet advised.
Duration7 Days after cessation of menses for Consecutive 3 monthsConsecutive 3 days after cessation of menses for Consecutive 3 months.
Improvement was assessed on 90th day
Follow up of patients was done on the basis of ovulation study which was done from 9th day onwards till 22nd day depending upon the Ovulation.

Table 2: Showing Assessment Criteria with Grading

SNSubjective ParameterSeverity of SymptomsGrade
1. Pain during MensesNo pain0
Mild Pain1
Moderate Pain2
Severe Pain3
2. Duration of Menstruation4 - 5 days0
3 days1
1 - 2 days2
1 day3
3.Interval Of Menstruation21 to 35 days0
36 to 45 days1
46 to 55 days2
More than 55 days3
4.Quantity of Bleeding2-3 pads/day0
1-2 pads /day1
1 pad/day2
No Bleeding / Spotting3
5.Follicle SizeOvulated0
>20 mm1
12-19 mm2
< 12 mm3
6.Viscosity of Cervical MucousSticky, Resembles egg white0
Mildly Viscous1
Intermediate Type2
Highly viscous, non-sticky3

Statistical Analysis

ParametersIntragroup resultIntergroup comparison
Subjective parameterWilcoxon Signed rank testMann Whitney U test

Diagnostic Criteria

  • Menstrual disturbances -Oligomenorrhoea, Irregular Menses
  • Hormonal assessment
  • Ultrasonography (USG)
  • Follicular study

Withdrawal Criteria

  • Any Intercurrent Illness.
  • Personal reason.
  • If any Side effect occurs

Investigations

  • Routine blood and Urine Examination
  • Hormonal Profile (S. Prolactin, S. TSH, S. FSH, S. LH, AMH, S. Progesterone)
  • USG
  • TVS for Follicular Study
  • Serological Examination to screen for HIV, HbsAg, HCV, VDRL.
  • Human Semen Analysis

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Assessment

The assessment was done on the Subjective parameters and Overall assessment and scoring was done before and after the Treatment.

Result

Effect of Matra Basti (Group A) On Subjective Parameters

(Wilcoxon Signed Rank test)

Ranks
VariablesNMean RankSum of RanksZ ValueP ValueResult
Pain during menses_AT – Pain during menses_ BTNegative Ranks10a5.5055.00-2.972b.003S*
Positive Ranks0b.00.00
Ties8c
Total18
Duration of menses_AT -Duration of menses_BTNegative Ranks12d6.5078.00-3.176b.001S*
Positive Ranks0e.00.00
Ties6f
Total18
Interval between two cycles_AT – Interval between two cycles_BTNegative Ranks12g6.5078.00-3.145b.002S*
Positive Ranks0h.00.00
Ties6i
Total18
Quantity of bleeding_AT- quantity of bleeding_BTNegative Ranks15j8.00120.00-3.542b.000HS**
Positive Ranks0k.00.00
Ties3l
Total18
Follicular size_AT-Follicular size_BTNegative Ranks11m6.0066.00-3.127b.002S*
Positive Ranks0n.00.00
Ties7o
Total18
Viscosity of cervical mucous_AT-Viscosity of cervical mucous_BTNegative Ranks13p7.0091.00-3.419b.001S*
Positive Ranks0q.00.00
Ties5r
Total18

S* - Significant, HS**- Highly significant

Improvement of Subjective Parameters in Each Group

SNSubjective parametersResult in Percentage
Group A (in %) (n=18)Group B (in %) (n=15)
1.Pain during menses52.2%51.6%
2.Duration of Menses51.8%70.6%
3.Interval between two cycles64%76.9%
4.Quantity of bleeding62.3%83.1%
5.Follicular size27.2%59.8%
6.Viscosity of Cervical mucous30.5%53.8%
Average % of relief48%65.9%

Overall Effect of Therapy

Group AGroup BOverall effect
%NN%N%
Complete Remission :100% relief (Ovulation)15.6%640%721.21%
Marked Improvement: >75% relief to <99 % relief (Increase in size of follicle i.e., 19-23mm)15.5%320%412.12%
Moderate Improvement: >50 % to 74 % relief (Increase in size of follicle i.e., 12-19 mm)1477.7%533.4%1957.56%
Mild Improvement: <25% to > 49% relief (< 12mm size of follicle)211.3%16.6%39.09%
Total18100%15100%33100%

Effect of Uttara Basti (Group B) On Subjective Parameters

(Wilcoxon Signed Rank test)

Ranks
VariablesNMean RankSum of RanksZ ValueP ValueResult
Pain during menses_AT - pain during menses_BTNegative Ranks9a5.0045.00-2.739b.006S*
Positive Ranks0b.00.00
Ties6c
Total15
Duration of menses_AT- duration of menses_BTNegative Ranks11d6.0066.00-3.002b.003S*
Positive Ranks0e.00.00
Ties4f
Total15
Interval between two cycles_AT – interval between two cycles_BTNegative Ranks5g3.0015.00-2.236b.025S*
Positive Ranks0h.00.00
Ties10i
Total15
Quantity of bleeding_AT- quantity of bleeding_BTNegative Ranks13j7.0091.00-3.272b.001S*
Positive Ranks0k.00.00
Ties2l
Total15
Follicular size_AT - follicular size_BTNegative Ranks14m7.50105.00-3.384b.001S*
Positive Ranks0n.00.00
Ties1o
Total15
Viscosity of cervical mucous_AT- viscosity of cervical mucous_BTNegative Ranks13p7.0091.00-3.247b.001S*
Positive Ranks0q.00.00
Ties2r
Total15

S* - Significant


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Intergroup comparison in various Subjective parameters of Bandhyatva by Mann Whitney test

Ranks
VariablesGroupNMean RankSum of RanksZ ValueP ValueResult
Pain during menses_BTA1815.17273.00-1.265.206NS*
B1519.20288.00
Total33
Pain during menses_ATA1815.75283.50-.881.378NS*
B1518.50277.50
Total33
Duration of menses_BTA1817.42313.50-.300.764NS*
B1516.50247.50
Total33
Duration of menses_ATA1819.31347.50-1.702.089NS*
B1514.23213.50
Total33
Interval between two cycles_BTA1819.39349.00-1.664.096NS*
B1514.13212.00
Total33
Interval between two cycles_ATA1819.33348.00-1.807.071NS*
B1514.20213.00
Total33
Quantity of bleeding_BTA1817.92322.50-.628.530NS*
B1515.90238.50
Total33
Quantity of bleeding_ATA1819.39349.00-1.782.075NS*
B1514.13212.00
Total33
Follicular size_BTA1817.00306.00.0001.000NS*
B1517.00255.00
Total33
Follicular size_ATA1820.64371.50-2.651.008S**
B1512.63189.50
Total33
Viscosity of cervical mucous_BTA1817.56316.00-.451.652NS*
B1516.33245.00
Total33
Viscosity of cervical mucous_ATA1820.28365.00-2.280.023S**
B1513.07196.00
Total33

NS* - Not Significant, S**- Significant

jaims_2859_01.JPG

Discussion

Discussion on Post Treatment (Result)

Effect of Therapy on Pain during menses:

Group A was found with better result with Average % of relief 52.2% and

Significant p value (p>0.005). Matra Basti stimulates the CNS through ENS and helps to excrete increased prostaglandins which result in activation of HPA Axis and ANS involving the release of neurotransmitters like Serotonin, thus relives dysmenorrhoea.

Effect of Therapy on Duration of menses:

Group B was found with better result with Average % of relief 70.6% and Significant p value (p>0.005). The Emmenagogue and Fibrolytic action of most of the contents of Jeevantyadi Yamaka Uttara Basti may be the responsible factor for the increase of flow days.

Effect of Therapy on Interval between two cycles:

Group B was found with better result with Average % of relief 76.9% and Significant p value (p>0.005). Ushna, Tikshna, Lekhana, Pachana etc. properties of contents of Jeevantyadi Yamaka increases the Agneya guna of Pitta which is responsible for decreasing interval. This effect is also supported by Vatanulomana property of Uttara Basti.

Effect of Therapy on Quantity of bleeding:

Group B was found with better result with Average % of relief 59.8% and Significant p value (p>0.005). Jeevanti is Vasodilator, hence the drug when instilled directly into the Uterus in the form of Uttar Basti, causes vasodilatation of the spiral arteries in the Uterus thereby increasing the endometrial proliferation hence increases menstrual flow.

Effect of Therapy on Follicular size and Ovulation:

Group B was found with better result with Average % of relief 83.1% and Significant p value (p>0.005). Most of the contents of Jeevantyadi Yamaka have Ushna, Tikshna, Kapha-Vatashamaka, Vatanulomaka, Srotoshodhana, Amapachana, Artava Janana and Garbhashaya Sankochaka property, thus, relieves the Kapha which has done Avarana of Apana Vayu by blocking the Artavaha Srotasa and therefore removes the Margavarodha leading to Rajah Pravritti and Beeja Nirmana. Uttara Basti causes local uterine contractions which stimulates the ovarian hormone. Ovaries contain receptor which receives the hormone secreted from


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hypothalamus and pituitary gland, thus regulate the HPO Axis regulating the menstrual cycle with Ovulation. Uttara Basti stimulates these receptors so that Maturation of follicles and ovulation occurs in each cycle.

Effect of Therapy on Viscosity of Cervical mucous:

Group B was found with better result with Average % of relief 53.8% and Significant p value (p>0.005). As Uttara Basti is a local treatment, the drug is administered locally in the Cervix which is directly absorbed by the cervical epithelium because of the Sukshma property of the drug and thus directly acts on Cervical mucous. Due to the Laghu and Ushna Guna of contents of Jeevantyadi Yamaka, it decreases the Picchilata of Kapha and increases thinness (fluidity) of mucus, thus, the viscosity decreases and hence spinbarkeit increases.

Overall Effect of Therapy

In the present study, in 21.2% of patients Ovulation occurred, 12.1% of patients reported marked improvement in the size of follicles i.e., 19-23 mm, 57.6% of patients reported moderate improvement in the size of follicles i.e., 12-19 mm and 9.1% of patients reported mild improvement or no growth in the size of follicles i.e., <12 mm.

No patient got conceived during and after the trial.

Average % of relief was higher in Group B i.e., 65.9% followed by Group A i.e., 48%.

Overall, Group B had a higher percentage of individuals achieving Ovulation and marked improvement. On the other hand, Group A had a higher percentage of individuals experiencing moderate improvement. Both groups had a relatively small number of individuals showing mild improvement.

Discussion on Drug

Probable mode of action of Jeevantyadi Yamaka

  • Jeevantyadi Yamaka contains 16 ingredients i.e., Jeevanti, Madan, Meda, Gorakhmundi, Madhuka, Bala, Shatapushpa, Rishibhaka, Pippali, Kaknasa, Shatavari, Kaunch, Ksheerakakoli, Karkatshringi, Shati, Vacha, along with Go dugdha, Moorchita Go ghrita and Tila taila.
  • Rishibhaka, Meda and Ksheerakakoli
  • Due to the non-availability of , Pratinidhi dravyas Vidarikanda, Shatavari and Ashwagandha were used which resulted in double quantity of Shatavari and ultimately increased the Rasayana property of the drug.
  • Majority of the drugs having Vata-Kapha shamaka, Deepana-Pachana, Vatanulomaka, Vrishya, Rasayana, Shothahara, Balya, Yonidoshahara, Garbhasthapaka properties mostly with Laghu, Ushna, Teekshna guna. These may remove Avarana of Kapha and might have restored the normal functioning of Vata and Follicular development.
  • Ingredients like Jeevanti, Madhuyashti, Bala, Ashwagandha, Vidarikanda, Shatavari, Kaknasa, Kaunch have Madhura rasa and qualities like Rasayana, Balya, Brimhana which is responsible for Upchaya (Kapha Dosha) thereby improves the Endometrial thickness as well as quality of cervical mucous and may increase the muscular strength of Reproductive system
  • Some drugs like Shatapushpa, Pippali, Gorakhmundi, have Deepana-Pachana and Ama-dosha nashaka properties so it regulates Jatharagni, Dhatvagni and Bhutagni by the action of Samana Vata which corrects metabolism at cellular lever which result in proper formation of Dhatus and Upadhatus (Artava) and Srotoshodhana by removing Ama.
  • By Ushna Virya, Katu Vipaka, Tikta Rasa and Katu Guna of Madan, Gorakhmundi, Shatapushpa, Karkatshringi, Shati and Vacha, it clears the Srotosanga and Stimulates the Srotasa, thus making the proper function of Artavagni by which Ovulation may occur and Menstrual cycle is regulated.
  • Because of Madhura Vipaka and Sheeta Virya of Jeevanti, Madhuka, Vidari, Kaknasa, Shatavari, Go-Ghrita and Go-Ksheera, it does the Poshana and Brihana of Yoni. Thus, may enhance the follicular growth by increasing the blood supply and regularising the function of
  • The Emmenagogue and the fibrolytic action of Madana, Shatapushpa, and Shati may be the responsible factor for the increase of flow days.
  • Bala, Gorakhmundi, Vidari, Kapikacchu, Ashwagandha have Anti-oxidant property which decreases oxidative stress.
  • Shatavari

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  • is Garbhaposhaka. It nourishes the Uterus and Ovum and prepares the female organ for pregnancy and prevents threatened miscarriage.
  • The Hypoglycaemic property of Shatavari and Jeevanti decreases androgen production and stimulates the hepatic production of S.HBG, thus relieving the symptoms of PCOS.
  • Shatavari, Shatapushpa, Jeevanti, Bala, Vidari, Kapikacchu, Ashwagandha, Karkatshringi contains β-Sitosterol (phytoestrogens), the precursor of Estrogen. Due to their Phyto-estrogenic effect increases amount of cervical mucous, spinbarkeit, ferning, motility and density of sperm in cervical mucous. Phyto-estrogenic effect may also help in regulating the HPO axis and thus regulates menstrual cycle and Ovulation.
  • Stigmasterol present in Jeevanti and Vidari, is a precursor of progesterone, acts as intermediate in the biosynthesis ofandrogens, estrogens, andcorticoids.[13]
  • According to Modern Science, Sneha is Lipophilic in nature. Thus, it diffuses rapidly across the cell membrane which is also composed of bimolecular lipid matrix and Sneha can cross blood brain barrier and act on CNS i.e., Hypothalamus and Pituitary gland and may correct hormonal imbalance. Ghrita contains Beta-carotene and Vitamin E which itself are anti-oxidant. Ghrita and Taila contains cholesterol which is responsible for the synthesis of steroid hormones i.e., Estrogen & Progesterone.
  • The Causative factor of Bandhyatva is mainly vitiation of Vata. Acharya Charaka says that all the gynaecological disorders are due to vitiation of Vata and maximum drugs of Jeevantyadi Yamaka are having Vatashamaka and Vatanulomaka By keeping Doshas in Samyavastha, it may ensure proper functioning of Dhatus.
  • Thus, we can say that by Katu and Tikta Rasa, Laghu, Snigdha guna, Ushna Veerya, Anulomana, Deepana and Pachana Karma, Jeevantyadi Yamaka digests the Ama at the cellular level and pacify the vitiated Vata and Kapha Dosha. Due to the Ama-pachana and Kapha-vatashamana, Avarana and Sanga of Vata-Kapha dosha
  • is removed and Apana Vayu get normalised and do its normal function (Beejotsarga).

Discussion on probable mode of action of Matra Basti on Ovulation

Mode of action of Purvakarma

Sthanika Abhyanga and Swedana prior to Matra Basti do its Anulomana and thus, Basti becomes more efficacious. Besides this, chances of any type of complication are also less, if Vatanulomana is done prior to procedure. Other than it, Abhyanga and Swedana just prior to Matra Basti, relaxes abdominal muscles, increases metabolism and blood circulation because of vasodilation.

Flowchart 1: Showing Mode of Action of Jeevantyadi Yamaka
jaims_2859_02_a.JPG

Mode of action of Pradhana Karma

  • When lukewarm Sneha is given through rectum it reaches instantly into systematic circulation thus has faster absorption and quick results. Mild Temperature of Sneha enhances its diffusion.
  • ENS controls the motility,

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  • exocrine and endocrine secretions and microcirculation of the G.I. tract. ENS closely resembles CNS. Endogenous opioids are mainly present in G.I.T and in Brain (Hypothalamus, Pituitary).
  • β endorphin has a role in regulation of normal menstrual cycle. The essence of Matra Basti stimulates endogenous opioids which are usually present in GIT.
  • These endogenous opioids (β endorphin) may influence GnRH release and aids to regulate Hypothalamo-pituitary ovarian axis and thus regulates the ovarian cycle.
  • Thus, Matra Basti stimulates the ENS, generates the stimulatory signals for CNS, causes stimulation of Hypothalamus for GnRH and Pituitary for FSH and LH with the help of Neurotransmitters.

Flowchart 2: Showing Mode of Action of Matra Basti on Ovulation
jaims_2859_03.JPG

Probable Mode of Action of Uttara Basti on Ovulation

Probable Mode of action of Purvakarma

  • Haritaki Churna given one night prior to Uttara Basti, helps to alleviate constipation and thus may be helpful in bringing Pratimola Apana Vayu back to normalcy.
  • Sthanika Abhyanga and Swedana prior to Uttara Basti do its Anulomana and thus, Uttara Basti becomes more efficacious. Besides this, chances of any type of complication are also less, if Vatanulomana is done prior to procedure. Other than it, Abhyanga and Swedana just prior to Uttara Basti, relaxes abdominal muscles, increases metabolism and blood circulation because of vasodilation.
  • Yoniprakshalana done prior to Uttara Basti with Panchavalkal Kwatha nullifies the possibility of any type of infection as a complication.

Probable Mode of action of Pradhana Karma

  • When lukewarm Sneha enters into the Uterine Cavity, network of Srotasa carry the Sneha towards the Artavaha Srotasa. Mild Temperature of Sneha enhances its diffusion.
  • Uttara Basti, which is given in Garbhashaya, i.e., Artavaha Srotasa stimulates the Srotasa as well as Beejagranthi. By the stimulation of Ovary, the Sanga in the Beejagranthi is removed and Vata performs its two functions properly i.e., Vibhajana (reduction division in oocyte, proliferation of granulosa cells and responsible for development of follicle along with Kapha) and Pravartana (rupture of follicle i.e., Ovulation).
  • Uterus is the Mulasthana of Artavavaha Srotasa. The drug directly being instilled in the Uterus gives direct access to the seat of Sroto vaigunya and Dosha-Dushya-Sammurchana and hence acts on the Vikrita Vayu thereby disintegrating the Samprapti. In condition of anovulation, Uttar Basti removes the Srotosangha and corrects the Artavagni which regulates the menstrual cycle, thus resulting in ovulation. Uttara Basti causes local uterine contractions which stimulates the ovarian hormone. Ovaries contain receptor which receives the hormone secreted from hypothalamus and pituitary gland, thus regulate the HPO Axis regulating the

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  • menstrual cycle with Ovulation. Uttara Basti stimulates these receptors so that Maturation of follicles and ovulation occurs in each cycle.

Flowchart 3: Showing Mode of Action of Uttara Basti on Ovulation
jaims_2859_03.JPG

Conclusion

In all the assessment parameters both the treatment modalities i.e., Jeevantyadi Yamaka Matra Basti and Uttara Basti are equally effective except Follicular size and viscosity of Cervical mucous. But in overall, Jeevantyadi Yamaka Uttara Basti was more effective in achieving Ovulation due to its local effect. As, this study was only for three months so no result was seen on Conception.

References

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8. Vidya Rani, Ch. Ravindra, UTTAR BASTI AND AYURVEDA PROTOCOL IN THE MANAGEMENT OF PRIMARY INFERTILITY – A CASE REPORT, International Journal of Ayush Case Report, Vol 1 No 1 (2017): July-Sept:2017, e-ISSN :2457-0443

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10. Bhagyashri Khot, Dr. Veena Patil and Dr. Pramila Shinde, A CONCEPTUAL STUDY ON {ABEEJOTSARGA} ANOVULATION – A REVIEW, World Journal of Pharmaceutical Research, Volume 8, Issue 12, 291-298, ISSN 2277– 7105

11. Ashtanga Hridaya, edited-Vidyotini, Hindi commentary by Kavi raja Atrideva Gupta Edited-Vaidya Yadunandana Upadhyaya, Kalpa Sthana, Chap. 4, Shloka 49,60,61,62, Chaukhamba Prakashan, Varanasi,2019.


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https://en.wikipedia.org.Stigmasterol


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